Can my depression harm the baby while I'm pregnant?

It might. If you're suffering from depression while you're pregnant, it's important for your health—and your baby's health—that you get the help you need.

Depression during pregnancy is a common problem, impacting around 10 percent of pregnant women. Still, it's often overlooked or undiagnosed by medical providers, family, and even the pregnant women who are suffering from it.

For some women, common experiences during pregnancy might resemble symptoms of depression, such as sleep disruption, appetite changes, difficulty concentrating, and lack of energy. In addition, fear of stigma or lack of information remains a powerful force preventing women from seeking help.

You might be reluctant to take anti-depressant medication while you're pregnant, for fear of exposing your baby to the effects of the medication. In fact, sometimes women who are already being treated with anti-depressants stop taking their medications once they see their positive pregnancy test. And these medications do come with some potential risks.

But untreated depression in pregnancy also bears risks, not only for the mother herself (unhealthy coping behaviors such as smoking or not following up with prenatal care or eating an unhealthy diet, for example), but also for her unborn child.

Depressed pregnant women show higher levels of prenatal stress hormone (cortisol) compared to healthy women, a possible explanation for some associated risks. Women who are depressed during pregnancy have smaller babies in mid pregnancy and slower fetal growth compared to non-depressed women. They're more likely to have premature delivery and babies with low birth weight.

Newborns of depressed moms show significantly higher urinary stress hormone themselves, compared to those of healthy mothers, which makes them more stress reactive, temperamentally difficult, and more challenging to care for and soothe.

In terms of long-term outcomes, there's some evidence that children exposed to maternal depression in pregnancy face more social and emotional problems as young children, such as aggression and other conduct problems. Negative impact on child IQ and language has also been proposed. Some researchers suggest that the outcomes are worst or only found for those children whose mothers show recurrent depression, with episodes in pregnancy and again later in development, or for those children who are exposed to additional risks, such as maltreatment.

You're likely wondering what's worse, having untreated depression in pregnancy or taking antidepressants. Luckily, we have now collected over 30 years of data on the effects of antidepressant use in pregnancy on the fetus, and perinatal psychiatric experts feel pretty confident making recommendations.

Clinical researchers have recently reviewed over 290 published studies on the impact of untreated depression on fetal and child outcomes compared to the published data on the harm posed by in-utero exposure to antidepressants. They basically found that both untreated depression during pregnancy and antidepressants may carry some risks for the developing baby. (Antidepressants may carry the risk of neonatal distress and sleep problems, for example.)

In some circumstances, the risk to your baby of your taking antidepressants may seem almost identical to the risk of untreated depression. But at other times, your depression may be so severe that you can't function or don't want to go on with your life. In this case, the risks of untreated depression to you and your child outweigh any risks from antidepressants.

A carefully obtained individual history of prior depressions and/or of family history and other risk factors for depression can help determine your personal risk or resilience. At the end of the day, you, your family and your doctor need to have an honest, personal risk-benefit discussion to determine the best treatment strategy for you and your baby.

If you're suffering from depression during pregnancy, talk with your doctor about the risks and benefits of specific medications for you in your unique circumstances—considering your stage of pregnancy, the severity of your depression, and the likelihood of relapse, for example. Explore alternatives to medications, too, such as evidence-based psychotherapy, exercise, prenatal yoga, bright-light therapy and/or mind-body modalities such as meditation or mindfulness practice, all of which are currently being heavily researched and are proven to be safe.

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